MEDICARE: PHOENIX UROLOGICAL SURGEONS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician

General Provider Information

NPI Number	:	1811908544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX UROLOGICAL SURGEONS PC

Provider Business Mailing Address
First Line	:	19841 N 27TH AVE
Second Line	:	SUITE 201
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4005
Country	:	US
Telephone Number	:	623-582-6420
Fax Number	:	623-582-6720

Provider Business Practice Location Address
First Line	:	19841 N 27TH AVE
Second Line	:	SUITE 201
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4005
Country	:	US
Telephone Number	:	623-582-6420
Fax Number	:	623-582-6720

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JACK NILS BENSON
Credential	:	DO
Telephone Number	:	623-582-6420

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	02/06/2014

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